The best way to avoid getting the flu is to get the flu vaccine. This year, the flu vaccine includes coverage for the H1N1 vaccine. The vaccine is available by shot or nasal spray (Flumist). The flu vaccine works by exposing your immune system to the flu virus. Your body builds up antibodies to the virus to protect you from getting the flu. The flu shot contains dead viruses. The nasal spray vaccine contains weakened live viruses. There is also a new product, Fluzone High Dose for people 65 years and older.

All individuals 6 months and older should get the seasonal flu vaccine.

The following people are at high risk for complications from the flu, or are contacts of individuals at high risk for complications from the flu:

• Pregnant women
• Children < 5 years old
• People > 50 years old
• Those with chronic medical conditions (asthma, diabetes, heart or kidney disease)
• People who live in nursing homes, long-term care facilities
• Health care workers
• Household contacts and out of home caregivers of children < 6 months old

The following individuals will need to get 2 doses of vaccine:

• Children 6 months – 8 years old who have never received seasonal flu vaccine.
• Children 6 months – 8 years old who received seasonal flu vaccine for the first time in 2009-10 but only received one dose.
• Children who have not received at least one dose of the H1N1 2009 vaccine, regardless of previous flu vaccine history.

You cannot get the flu from the flu shot or the nasal spray vaccine.
Some people get a little soreness or redness where they get the shot. The nasal mist might cause nasal congestion, runny nose, sore throat, and cough.

Reduce your risk of catching the flu by washing your hands frequently to stop the spread of germs. Eating healthy, exercising, and getting enough sleep all help prevent the flu because they help boost your immune system.

If you get the flu, you may treat the symptoms with over the counter medications until you feel better. Get plenty of rest, drink a lot of fluids, avoid alcohol and smoking. Warm, salt water gargles, throat sprays or lozenges help relieve a sore throat. Analgesics such as acetaminophen, naproxen and ibuprofen help relieve aches and pains and reduce fever. Expectorants help thin mucus so it can be coughed up more easily. Antitussives (cough suppressants) help stop coughing, but do not take if you are coughing up mucus. Do not give antitussives to children under 4 years old.

Call your doctor if you or your child has a high fever lasting more than 3 days, breathing difficulty, chest pain, fainting, ear pain, vomiting, abdominal pain, changes in mental state (confusion, disorientation), symptoms lasting more than 10 days, or sinus pain.

In severe cases, your doctor may prescribe an antiviral medication.

Pertussis continues to spread and has resulted in the hospitalization and death of young infants who are too young to get vaccinated for it. Close contacts, most often mothers, are the most common source of pertussis in infants. All women of childbearing age should be vaccinated with Tdap, preferably before pregnancy, but otherwise during or immediately after delivery. All household contacts, health care personnel, and child care workers should be vaccinated against pertussis at least 2 weeks before their contact with young infants.

Vaccination against pertussis is part of the normal early childhood shots that children get before grade school. Protection from the childhood vaccines begins to wear off 5 – 10 years after vaccination. The CDPH (California Department of Public Health) and the CDC (Centers for Disease Control and Prevention) recommends that most teens and adults get the Tdap booster for protection against whooping cough if they have not been vaccinated.

Those at higher risk for vitamin D deficiency include: breastfed infants, older adults, people with limited sun exposure, dark skinned individuals, people with fat malabsorption (diseases such as cystic fibrosis, Crohn’s disease), people who have undergone gastric bypass surgery, and the obese.

Your body creates vitamin D after you are exposed to sunlight. Sunlight stimulates the conversion of a naturally occurring compound in the skin to an active (usable) form of the vitamin. 10 minutes of sunshine 3- 4 times per week may be enough to help your body create the vitamin D it needs.

Children from birth to 18 years of age need 400 IU of vitamin D daily. Breastfed babies may need a prescription vitamin supplement with vitamin D (from your physician) because human milk only has a small amount of vitamin D. Once the child is weaned, he/she should consume > 1 liter/day of vitamin D fortified formula or whole milk. Always ask your physician before giving your child any vitamin supplements.

Adults need at least the following amounts of vitamin D:

• <50 years of age: 200 – 400 IU daily
• 50 – 70 years of age: 400 – 600 IUdaily
• >70 years of age: 600 – 800 IU daily

Children and adults who do not get any sunshine may need 800 – 1000 IU daily.

Foods such as fish, fish oil, eggs, and cheese naturally contain vitamin D. You can purchase vitamin D fortified milk, orange juice, yogurt, margarine, and cereal. Vitamin D supplements are available over the counter or by prescription.

Be active. Get 30 minutes of exercise 4 – 5 times per week. Try and do something active every day. Take a walk. Take the stairs. Clean the house. Do some gardening. Take surfing lessons. Take an exercise class. Take dance lessons. Get the kids away from the television and video games and enroll them in organized sports. Take the kids to the YMCA.

Watch what you drink. Avoid soft drinks, cream coffees, alcohol, fruit juices/drinks, energy drinks, sweetened iced tea, and flavored milk. Water is a great way to keep your stomach full without taking in extra calories.

Do not skip meals. Regular meals increase your metabolism. Skipping meals causes your body to go into protective/hibernation mode, making weight loss harder. Eat a healthy breakfast. People who skip breakfast tend to weigh more.

Avoid fast food. Fast food such as hamburgers, chicken nuggets, french fries, pizza is high in calories and can cause weight gain. Pack a healthy lunch instead of eating out. This way you can control what and how much you eat.

Don’t grocery shop when you are hungry.

Chew sugar-free gum between meals to cut down on snacking.

Eat a lot of fruits and vegetables. Aim for 3 cups of vegetables and 2 cups of fruit daily.

Do not eat in a hurry. Chewing your food and eating slowly helps the digestive process. Eating slowly will help stop over-eating. It takes time for your stomach to signal your brain that you are full.

Consider joining a weight management group such as Jenny Craig or Weight Watchers. Receive encouragement and support from others.

Be prepared when you visit your physician with the following information: countries/regions that you will visit, duration of travel, season of travel, planned activities (scuba diving, hiking, etc). Bring a copy of your vaccine record if available. Once your physician evaluates your overall health and assesses your travel plans, he/she can provide information about the health risks that you could potentially encounter and give advice to minimize these risks. A travel consult should provide you with peace of mind while travelling.

Vaccines – Vaccines provide valuable protection for people who wish to travel in good health. Your physician will determine if you need any vaccines. The vaccines you received in childhood may need to be updated. Depending on your destination, you may need vaccines for some of the following: Hepatitis A and B, Influenza, Japanese encephalitis, MMR, meningitis, pneumococcal, polio, rabies, tetanus, typhoid fever, chicken pox and yellow fever.

Food and water safety – precautions are necessary in areas where sanitation and personal hygiene is poor. Drink water from commercially-sealed bottles, carbonated beverages, and beer/wine. Use bottled or boiled water when brushing teeth. Steaming-hot, well-cooked food is safest. Avoid street vendors, raw/uncooked seafood or meat, unpasteurized dairy products. Peel fruits yourself. Do not eat raw vegetables.

Malaria prevention – Malaria is a serious infection spread by the bite of an infected mosquito. Antimalaria medication is recommended if travelling to certain areas.

Insect and tick bites – Insects and ticks can transmit potentially life-threatening infections. Avoid insect-infested areas. Use repellent containing DEET or picaridin. Wear protective clothing such as long sleeves and pants. Follow good personal hygiene. Certain areas may need mosquito netting over the bed.

Personal medications – Bring enough medication for your entire trip, in their original containers. Place in your purse or carry-on to avoid loss/theft. Obtain a letter from your physician documenting medical need if you require syringes to administer medication.

Bring a first-aid kit – consider including: your personal medications. An antibiotic in case of traveler’s diarrhea. Pepto Bismol, Imodium. Cough and cold medicines. Pain medicine such as Tylenol or Advil. Allergy medication. Benadryl in case of allergic reaction. Sunscreen. Antibiotic ointment, bandages. Hydrocortisone cream. Moleskin. Motion sickness medication such as Dramamine. Altitude sickness medication such as Diamox depending on travel destination. Scissors, tweezers, pocket knife, thermometer, mirror, nail clippers. Hand wipes, sanitizers.

Sexually transmitted diseases – STDs such as HIV, hepatitis B, gonorrhea, Chlamydia, syphilis, herpes are all transmitted by sexual contact. These STDs are often more prevalent in developing countries. Use barrier methods such as condoms to reduce the risk of STDs. Avoidance of sexual contact eliminates the risk of acquiring STDs during travel.

Blood clots – for flights longer than 6 hours, precautions should be taken to avoid getting blood clots. Sitting for prolonged periods may cause blood pooling in the legs, increasing the risk of developing a blood clot. Stand up and walk around every hour, stretch frequently, avoid dehydration, consider wearing compression stockings. Avoid medications that impair your ability to move around (sleep aids, alcohol).

Avoid transportation problems/accidents – avoid night driving, wear your seat belt, do not drink alcohol and drive, be familiar with local driving customs/laws, wear a helmet on motorized cycles.

You may consider purchasing extra traveler’s health insurance. Check your health insurance policy and know your coverage.

There are additional travel considerations necessary for people travelling with medical conditions such as pregnancy, Diabetes, HIV. Ask your physician for advice or refer to the CDC website below.

Further information can also be obtained at The Center for Disease Control and Prevention (CDC) website, www.cdc.gov/travel/. The World Health Organization (WHO) has a similar site: www.who.int/ith/.

A second type of donation is a living donor. Donors can give kidneys, lungs, or parts of livers. Dr Chuck Wright, a past member of the SBFMG family chose to do this and continues to live a full life as a State Department Physician in India. His donation was to an unrelated recipient, but many donors give their organs to members of their family. Both blood type and tissue type compatibility are important in doing this. The donor must be in good health and usually under sixty years old. Most hospitals that perform transplant are large medical centers such as UCLA, USC, and Cedars Sinai. However, your SBFMG physician will gladly assist you should you have further questions or be interested in becoming a live donor.

Major medical associations have conflicting recommendations regarding prostate cancer screening. The US Preventative Task Force and many European medical cancer societies do not recommend routine PSA screening to detect prostate cancer. The American Cancer Society (ACS) and the American Urological Association believe men that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). Men with female relatives who have breast cancer related to the breast cancer gene (BRCA) may also be at increased risk.
This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).
If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).
Screening should not be performed on men older who are 75 years old and older.

References
American Cancer Society. Cancer Facts & Figures 2009. Atlanta, Ga: American Cancer Society; 2009.

The fact is, our spines are not well designed for upright human activity, but would better serve a 4 legged creature! Thus, we are by nature more susceptible to back and neck injury. Add to this some lazy posture and extra weight and we have the “perfect storm” for back problems.

I emphasize three factors to prevent back pain:
1. POSTURE: Always try to keep your ears, shoulders and hips in line, even when bending or reaching for something. This really means more bending with your knees when standing and using some type of lumbar support when sitting, especially when sitting in a car or in front of a computer.

2. FLEXIBILITY: Stretching your neck, back, and leg muscles every day can help avoid pulls and strains. This is especially important after the age of 35 when we all gradually loose a lot of our normal tissue elasticity. Ask your doctor or a physical therapist for information on proper stretching to prevent injuries.

3. STRENGTHENING: Strengthening your back actually means strengthening your core muscles, especially your abdominal muscles; this can be done with simple “crunches” or by more formal training such as pilates or yoga. You do not need to life weights to make your back stronger!

When it comes to back pain (as with many other conditions), “An ounce of prevention is worth a pound of cure!”

There are many blood types most commonly referred to by the A, B or O system with a second designation referring to being positive or negative. This second designation refers to “Rh” factor. Some blood types are less common than others, but that doesn’t affect the need for all types to donate. The fact that some blood types are more common only means that there are probably more people needing that type.

Blood is checked carefully for diseases before being given. In California, no payment is made for blood. This is thought to eliminate any motivation for providing blood other than “the goodness of your heart”. It also reduces the risk that someone would provide blood with any risk of disease.

The effects on the donor usually last only one or two days and unless the patient has high blood pressure or heart disease, these effects are minor. The time of donation is less than one hour and blood can be given about once per month. The long-term effects on donors have not been shown to be harmful. In fact, some reports have shown that donors live longer than those who do not give blood.

Please let us help you experience the sense of helping and making a difference by giving blood. The life you save could be your own or that of someone you love. Contact The Red Cross or your local hospital blood bank (Torrance Memorial Hospital Blood Bank 310-325-9110)

HOW DOES ACNE DEVELOP?
Acne is caused when hair follicles under your skin get clogged. Hair follicles become blocked with normal skin cells. The cells combine with an oily substance called sebum to create a plug in the hair follicle. Sebum is a naturally occurring oily substance produced by glands called sebaceous glands. We all have several sebaceous glands on our face, neck, back, chest and shoulders. If our sebaceous glands produce too much sebum, it allows for overgrowth of bacteria that normally lives on our skin. This can cause inflammation that ruptures the follicle and forms a pimple.

Sebaceous glands produce more sebum in response to hormones called androgens that increase in adolescence. Hormone changes related to pregnancy, or starting/stopping the birth control pill can cause acne. Acne can flare just prior to a woman’s menstrual period. Oils and greases in hair products or oil-based cosmetics can contribute to and worsen acne. Stress may worsen acne. There is no strong evidence that diet plays a role in causing acne. There may be an association with cow’s milk, due to the hormones found in milk.

TREATMENT FOR ACNE
If your acne is mild, you can use non-prescription topical products such as benzoyl peroxide, salicylic acid, sulfur, alpha hydroxy acids, and tea tree oil. Wash your face twice daily with a gentle facial cleanser and warm water. Do not scrub too vigorously or wash excessively because this can irritate your skin and worsen the acne. Use your hands to wash your face. This helps remove excess sebum and helps control the acne. If you have oily hair, shampooing daily decreases the amount of oil from your hair that reaches your skin. Choose oil-free skin products labeled “non-comedogenic” (does not cause blackheads or whiteheads) or “non-acnegenic” (does not cause pimples). If you have oily skin, choose a gel-based moisturizer. If you have dry skin, choose a cream or lotion. Choose a moisturizer with SPF 15 or higher. When using hair products, shield your face to prevent product from getting on your skin. Men who shave and who have acne should test both electric and safety razors to see which is more comfortable. Soften your beard with soap and water before applying shaving cream.

Consult your doctor if you have moderate or severe acne, or if the over the counter regimens are not helping. Depending on the type of acne you have, your family doctor may treat your acne with a topical medication, oral antibiotic, and/or a hormonal treatment. Dermatologists also use laser and light-based technologies to treat acne. If you have severe acne with nodules or cysts, then you may need to see a dermatologist to discuss Accutane.

Acne treatments prevent new pimples from forming. It takes 1- 2 months to effectively treat acne. Do not pick, pop, or squeeze pimples while waiting for treatment to work. This can worsen the acne and cause scarring. Be patient and work with your family doctor to find a treatment that works for you!